To Örebro University

Over the last decades, psychological mechanisms have been identified as key in the understanding of pain development and maintenance of vulvodynia. Furthermore, psychological treatments in the form of cognitive behavioral therapy (CBT) have proven helpful for those suffering. Still, prospective studies investigating psychological mechanisms over time are lacking, as are clinical studies investigating their role in treatment.

The overall aim of this dissertation is to further the understanding of pain-related behavior and its role in the development and maintenance of vulvodynia by applying a fear-avoidance-endurance theoretical framework. It further aimed at consolidating the understanding of such a framework through a clinical proof of concept investigating the effect of a CBT treatment. Study I investigated the mediating role of avoidance and endurance behavior on the relationship between pain catastrophizing and pain. Study II prospectively investigated the predictive value of avoidance and endurance behavior on sexual function. Further, avoidance and endurance behavior were examined on an individual level to gain information on potential patterns of behavior. Study III investigated the effect of a CBT group treatment with partner involvement on pain and associated outcomes.

Taken together, the overall findings of this dissertation further point at the importance of psychological mechanisms such as pain catastrophizing, avoidance behavior, and endurance behavior in the development and maintenance of vulvodynia. While further manifesting similarities between mechanisms involved in vulvodynia and those involved in other persistent pain conditions, the findings also verify the relevance of the Fear-avoidance model and the complementary Avoidance-endurance model for vulvodynia. Finally, a new model of understanding was proposed: the Fear-avoidance-endurance model of vulvodynia, summarizing pain-related behavior involved in the development and maintenance of vulvodynia.